title: Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients.
abstract: METHODS
  A prospective observational multicenter study.
  
  
  OBJECTIVE
  To help solve the debate regarding whether the anterior or posterior surgical approach is optimal for patients with cervical spondylotic myelopathy (CSM).
  
  
  BACKGROUND
  The optimal surgical approach to treat CSM remains debated with varying opinions favoring anterior versus posterior surgical approaches. We present an analysis of a prospective observational multicenter study examining outcomes of surgical treatment for CSM.
  
  
  METHODS
  A total of 278 subjects from 12 sites in North America received anterior/posterior or combined surgery at the discretion of the surgeon. This study focused on subjects who had either anterior or posterior surgery (n = 264, follow-up rate, 87%). Outcome measures included the modified Japanese Orthopedic Assessment scale, the Nurick scale, the Neck Disability Index, and the Short-Form 36 (SF-36) Health Survey version 2 Physical and Mental Component Scores.
  
  
  RESULTS
  One hundred and sixty-nine patients were treated anteriorly and 95 underwent posterior surgery. Anterior surgical cases were younger and had less severe myelopathy as assessed by mJOA and Nurick scores. There were no baseline differences in Neck Disability Index or SF-36 between the anterior and posterior cases. Improvement in the mJOA was significantly lower in the anterior group than posterior group (2.47 vs. 3.62, respectively, P < 0.01), although the groups started at different levels of baseline impairment. The extent of improvement in the Nurick Scale, Neck Disability Index, SF-36 version 2 Physical Component Score, and SF-36 version 2 Mental Component Score did not differ between the groups.
  
  
  CONCLUSIONS
  Patients with CSM show significant improvements in several health-related outcome measures with either anterior or posterior surgery. Importantly, patients treated with anterior techniques were younger, with less severe impairment and more focal pathology. We demonstrate for the first time that, when patient and disease factors are controlled for, anterior and posterior surgical techniques have equivalent efficacy in the treatment of CSM.
  
  
  METHODS
  3.
authors.affiliation: *University of Toronto, Toronto, Ontario, Canada †University of Washington, Seattle, WA ‡Emory University, Atlanta, GA §University of Kansas, Kansas City, KS ¶Thomas Jefferson University, Philadelphia, PA ‖University of Utah, Salt Lake City, UT **University of Virginia, Charlottesville, VA ††New England Baptist Hospital, Boston, MA ‡‡Boston Spine Group, Newton, MA §§Spine Education and Research Institute, Denver, CO ¶¶Brigham and Woman's Hospital, Boston, MA ‖ ‖Indiana Spine Group, Indianapolis, IN ***The CORE Institute, Phoenix, AZ; and †††John Hopkins University, Baltimore, MD.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: Sean
authors.initials: S
authors.lastname: Barry
authors.forename: Branko
authors.initials: B
authors.lastname: Kopjar
authors.forename: Sangwook Tim
authors.initials: ST
authors.lastname: Yoon
authors.forename: Paul
authors.initials: P
authors.lastname: Arnold
authors.forename: Eric M
authors.initials: EM
authors.lastname: Massicotte
authors.forename: Alexander
authors.initials: A
authors.lastname: Vaccaro
authors.forename: Darrel S
authors.initials: DS
authors.lastname: Brodke
authors.forename: Christopher
authors.initials: C
authors.lastname: Shaffrey
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Eric
authors.initials: E
authors.lastname: Woodard
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Banco
authors.forename: Jens
authors.initials: J
authors.lastname: Chapman
authors.forename: Michael
authors.initials: M
authors.lastname: Janssen
authors.forename: Christopher
authors.initials: C
authors.lastname: Bono
authors.forename: Rick
authors.initials: R
authors.lastname: Sasso
authors.forename: Mark
authors.initials: M
authors.lastname: Dekutoski
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009656:North America; D064887:Observational Studies as Topic; D011446:Prospective Studies; D013118:Spinal Cord Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D055009:Spondylosis / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome